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Institute for Clinical Pharmacology, niversity of Bern, urtenstrasse 35, Postfach 49, H - 3010 Bern,
Switzerland. jf.dufour@ikp.unibe.ch
Abstract
Keywords
Disease name and definition
Excluded diseases
Differential diagnosis
A brief history of NASH and its prevalence
Clinical description and diagnostic methods
Etiology and pathogenesis
Evolution
Treatment
References
Abstract
Patients with chronic, moderately elevated liver enzyme concentrations without a diagnosis after a clinical,
biochemical and radiological work-up are likely to suffer from non-alcoholic steatohepatitis or NASH. This
possibility is further supported by the presence of obesity, hyperglycemia and hyperechogenic hepatic
parenchyma. The diagnosis can be definitively made only by histological examination of a liver biopsy
containing lesions suggestive of ethanol intake in a patient known to consume less than 40 g of
alcohol/week. NASH is a common disease, with a prevalence around 1% of the general population similar
to that of hepatitis C. The natural history remains to be studied, but it is not necessarily benign:
cryptogenic cirrhosis in patients is a substantial number of probably end-stage NASH. The treatment is to
lose weight for the overweight patients, to correct the biochemical abnormalities like hyperglycemia and
hyperlipidemia and, if necessary to remove excess iron. Vitamin E and/or ursodeoxycholic acid may be
helpful, but such therapies should be prescribed within clinical trials as their efficacies remain uncertain.
Small trials have shown benefits of betaine and of a thiazolidinedione.
Keywords
Steatosis, hepatitis, aminotransferases, oxidative stress, cryptogenic cirrhosis, ursodeoxycholic acid,
vitamin E